New York City Mayor de Blasio was elected with a mandate to address the city’s deepening crisis of income and wealth inequality. Mr. de Blasio’s 2013 victory was echoed across the country as progressive candidates won mayoralties in cities such as Boston and Seattle. In light of federal inertia, the political will to tackle the troubling persistence of poverty and a diminished middle class has shifted to local municipalities. The first six months of Mayor de Blasio’s administration has been defined by important achievements in universal pre-K, paid sick leave, and a municipal ID. Moreover, Mayor de Blasio has stated that his approach to economic development will be premised on creating opportunities for all New Yorkers in the city’s high growth sectors including the technology industry which is essential to NYC’s creative and knowledge economy.

An example of the events that are taking place to engage in a public dialogue on New York City’s economic future took place last week at a half-day conference titled, Onramps of Opportunity: Building a Creative + Inclusive New York, with NYC Comptroller Scott Stringer and NYU-University of Toronto Professor Richard Florida, the “rock star” author of The Rise of the Creative Class. Presenters described how the spatial geography of New York City’s creative economy is increasingly centered in the industrial waterfront neighborhoods of Brooklyn and Queens where factories and warehouses are retrofitted, wired, and modernized to accommodate tech, media, entertainment, and artisanal manufacturing. Almost a mantra, conference attendees were told repeatedly, “every future job is a tech job”. Tensions between the creative class and neighborhood gentrification were alluded to as several presenters emphasized the need for affordable housing. However, it’s clear that meaningful inclusion extends beyond the provision of affordable housing as evidenced in the Extell Development Company’s project which will have separate entrances for tenants of its luxury and affordable housing units.

The re-branding of Brooklyn as an epicenter of creativity, innovation, and artistic production has achieved international success. On a recent trip to Istanbul, I was astonished by the prevalence of Brooklyn branding in clothing and cafes. Numerous Brooklyn neighborhoods such as Williamsburg, DUMBO, and Fort Greene are exemplars of the clustering of skills and talent and urban amenities such as bike paths, parks, and good coffee shops that support a creative economy and the lifestyle preferences of the creative class. The potential of this economic revival was recently explored in the PBS NewsHour clip “Could Brooklyn hipsters help save the middle class?”

The revitalization of Brooklyn may be the ultimate test for Mayor de Blasio’s vision of an inclusive urbanism. Acknowledging Brooklyn’s Sunset Park neighborhood as a nexus of the human and physical infrastructure necessary for equitable economic growth, Mayor de Blasio announced the formation of a Jobs for New Yorkers Task Force in front of the Brooklyn Terminal Army along Sunset Park’s waterfront. Heavily immigrant and working poor, Sunset Park’s Latino and Asian residents are largely concentrated in low paid service jobs. Sunset Park still retains a sizable number of garment factories that continue to rely on immigrant women workers. As Professor Florida described, these are the people that pour our coffee, take care of our kids and elderly parents, clean our homes, and make our food – jobs so essential to a creative city that Professor Florida extolled these workers as the “lifeblood of the city”. As one of New York City’s few remaining industrial neighborhoods, Sunset Park is now facing the challenges posed by a growing artisanal and creative economy. According to a recent New York Times article, the neighborhood’s extensive industrial building stock is being refurbished to accommodate a new Soho. Examples of tech and artisanal firms that now call Sunset Park home include MakerBot which manufactures 3-D printers and the internationally known Jacque Torres chocolatier. Even the Brooklyn Nets want to be in Sunset Park and are planning a 70,000-square-foot training facility with a rooftop terrace to enjoy the waterfront views.

The question of inclusion in New York City’s creative economy is essential to the future of neighborhoods like Sunset Park. Framing the afternoon’s discussion, Professor Florida stated that building an inclusive economy “will require all hands on deck” to formulate a new approach to economic development. Political will is just one of the necessary ingredients – policies that support unionization, affordable housing, living wages, worker cooperatives, workforce development and placement in jobs with avenues for economic mobility, and meaningful engagement in city planning and economic development decision-making are also essential. Working class, immigrant Latino-Asian Sunset Park is ground zero in testing the development and implementation of “onramps” for an inclusive creative city.

In this blog entry, Miriam Frank, author of Out in the Union, explores Harvey Milk’s political vision of union involvement and LGBT progress.

Two months ago the United States Postal Service issued a new “Forever” postage stamp to honor Harvey Milk. I remember when Harvey Milk won his seat on San Francisco’s Board of Supervisors in 1977. He was California’s first openly gay elected official.

A year later Milk was still campaigning, but not for himself. A new amendment to California’s state constitution was on the ballot for the November election. If Proposition 6 passed, it would require local boards of education to fire school employees for public or private declarations of their queer identities, as well as any school worker, straight or gay, who affirmed or advocated gay existence.

In June 1978, Milk spoke out against the menace of Proposition 6 to hundreds of thousands of gay people at San Francisco’s Gay Freedom Day rally. He challenged supporters to defy the threat by making their gayness more open than ever. “Come out to your friends, if they indeed are your friends,” he said. “Come out to your neighbors, to your fellow workers, to the people who work where you eat and shop.”

Milk organized hard against the amendment. Throughout the summer, he was on TV for interviews, or for debates with state Senator John Briggs, Proposition 6’s author. Milk’s prominence and charisma kept the battle in the news, but central to the fight were California’s lesbian, gay, bisexual and transgender citizens: city dwellers, suburbanites, rural folks. Many so feared how the amendment would affect their lives that they did come out. Sons, daughters, friends and co-workers told the people in their lives the truth about what the amendment would mean for their futures. One by one they asked their families and neighbors to vote “no on 6.” And one by one, they broke through the secrecy and fear that had held them back from living open, authentic lives as equals in civil society.

The decision to come out had to be an individual one, but LGBT people who were fighting Proposition 6 were not alone. Harvey Milk was not only dedicated to the gay community of the Castro but had also supported the municipal workers’ unions and a successful Teamster-led boycott of Coors beer in the neighborhood’s gay bars. Unionists were familiar with Senator Briggs’ record of hostility to labor’s issues and opposed the amendment because it would undermine collective bargaining and legalize workplace discrimination. Three days after the Gay Freedom Day rally, the San Francisco’s Labor Council announced its unanimous opposition to Proposition 6.

Union endorsements and donations enabled wide canvassing and publicity. By mid-summer, liberal religious groups and civil liberties organizations were also involved in the expanding grassroots campaign. Squads of queer activists knocked on doors in city and suburban neighborhoods and visited community meetings at union halls and country churches. In September, an endorsement of “No on 6” by former Governor Ronald Reagan, a right-wing rival of Senator Briggs, swung many more voters. Unions released the power of their political machine in late October with phone banks, a front- page editorial in the AFL-CIO newsletter and 2.3 million palm cards at the polls. On election day, Proposition 6 was rejected by 58 percent of California voters.

California’s successful defeat of Proposition 6 in 1978 was the first major political coalition to connect the fresh and angry power of gay liberation with labor’s long-haul commitment to fairness and equality. Many other great LGBT labor collaborations have flowed forth since then.

In my book, Out in the Union, I interviewed people who participated in those coalitions. My research began in 1995 and my search for stories continued for another several years. To explore the lives and achievements of primary activists, I conducted interviews in New York City, Boston, Detroit, Washington DC, Portland, Oregon, San Francisco, Seattle, Tacoma, Los Angeles, Salt Lake City and many places in between.

The lesbian, gay, bisexual and transgender union members who have told me their stories have been newspaper workers, nurses and health technicians, bus drivers, telephone installers, construction tradespeople, store clerks, hotel and restaurant employees, factory workers, social service workers and employees of AIDS clinics. Their queer lives have taken them through extraordinary adventures and long phases of everyday routine; and their everyday jobs are as various and their unions as diverse as the labor movement itself. Some have founded new union locals; others have negotiated innovative contracts; and still others have fought to save jobs when their plants were being closed. They are the people of Out in the Union.

Harvey Milk did not live to see the great changes that his activism started. But I like to think that he would have been proud of all that the labor and LGBT movements have accomplished.

The doctor won’t see you now

Tonya Battle had been working as a nurse in the neonatal intensive care unit (NICU) of the Hurley Medical Center in Flint, Michigan, for 24 years. Her employment record was spotless — by all accounts she was one of the most knowledgeable and capable care providers on the NICU floor. Even so, it wasn’t so surprising when, in the fall of 2012, one infant’s father asked to speak to Battle’s supervisor: Health is extremely personal, and no matter how skilled a health care provider, there will be times when communication with a patient breaks down. It’s common for a patient to ask for another doctor or another nurse.

What was shocking, however, was the note posted on the department assignment clipboard the next day: “NO AFRICAN AMERICAN NURSE TO TAKE CARE OF BABY.”

Here’s how the incident unfolded, according to allegations made by Battle in a lawsuit that followed: After she had finished her shift the day before, the father had come to the charge nurse (Battle’s supervisor) demanding that no black nurses attend to his (very sick) infant girl. To punctuate his point, he rolled up his sleeve to show off a swastika tattoo. The charge nurse, Deborah Herholz, then called her boss, the nurse manager Mary Osika, to ask what she should do. Osika said to reassign the baby to another nurse.

A staff meeting followed, in which the NICU nurses were told that Hurley Medical Center had decided not to allow any African-American employees to take care of this particular baby. The note was posted on the assignment clipboard for everyone to see.

The next day, Osika called Battle at home to inform her that the father’s request would be granted. Later that day, Battle reported to work, where one of her co-workers showed her a photo of the offensive note (which had since been removed).

Battle would go on to sue Hurley Medical Center for employment discrimination, settling out of court for an undisclosed amount, and with Hurley agreeing to hire an “employee advocate” whose role would be to forestall similar misadventures in the future.

It’s unclear how common these types of experiences are; there have been no major studies on the issue, so advocates and policymakers have had to rely on anecdotal evidence, the few isolated stories that leak out of the hospital wing and into the press. But many believe Hurley represents the norm and not the exception — that discrimination of this kind is endemic to the health care system.

The ‘open secret’

“I think it happens a lot,” said Julie Gafkay, Battle’s attorney. “I have 20 plaintiffs in the last year who have been subjected to this type of discrimination.” According to Gafkay, after Battle’s case was made public, dozens of other health care workers (nurses, social workers, home health aides, etc.) reached out to her with similar complaints.

Some situations were even more outrageous than Battle’s. In one case, the plaintiff is a human resources employee who says she has direct knowledge that an African-American nurse was fired under false pretenses; the real reason for the firing, she alleges, is that a patient had made the request that no African-Americans care for him.

It’s an “open secret” that “patients routinely refuse or demand medical treatment based on the assigned physician’s racial identity, and hospitals typically yield to patients’ racial preferences,” wrote Kimani Paul-Emile, a professor of law and biomedical ethics at Fordham University, in a 2012 study published in the UCLA Law Review.

So why aren’t more people outraged? Racism in health care settings tends to be much more insidious than the type of racism that would, say, make it onto the nightly news. Patients aren’t screaming racial slurs in the ER or spray-painting derogatory signs on the sides of hospital buildings. They often won’t even say outright that they don’t want a black doctor.

“Patients know it’s not PC” to directly request a white doctor, said Paul-Emile. “They come up with different ways to do it. I talked to this one doctor who said there are these older ladies who will say, ‘You know, I want a Jewish doctor, I just think a Jewish doctor is better.’”

Lisa Ruchti, a professor of sociology at West Chester University and the author of the book “Catheters, Slurs, and Pick Up Lines,” agreed. “Patients who want to fire their nurses based on race say things like ‘I want an American nurse,’” she said.

And hospitals comply. Health care providers are trained to be so patient-focused that even when they feel a request is amiss, many ignore their qualms — whatever the patient wants, the patient gets. In another of Gafkay’s current cases, two plaintiffs allege that an elderly white woman was being treated in the rehabilitation facility of a nursing home when she began to express fears that an African-American man was coming into her bedroom at night to “touch” her. The facility decided that, for the good of the patient, no African-Americans — male or female — would be assigned to her care, and it issued a directive to its staff saying as much. One female African-American nurse was even questioned for coming into the patient’s room at night, and suspended during the questioning.

“[The organizations] are so patient-focused,” said Gafkay, “that they ignore the civil rights of their own employees.”

Not just nurses

At particular risk is the nurse-patient relationship, which Ruchti believes is regularly informed by racism. In providing what Ruchti called “professional intimate care,” nurses are already at risk of being seen more as hired help than as health care professionals. And racist beliefs can exacerbate that misconception. “There are lots of examples of nurses of color being mislabeled as housekeepers by patients even when they are obviously doing nurse work — symbolically demoting them, if you will.”

But it’s not just nurses. Dr. Meghan Lane-Fall treats cardiovascular patients in the surgical care unit at the Hospital of the University of Pennsylvania.

“All of the things that are taught in medicine about being a care provider are to really not think about yourself or your characteristics,” Lane-Fall said. “Your gender and ethnicity are, in theory, erased when you walk through the doors of the hospital.”

But in reality, as an African-American woman, Lane-Fall is often subjected to racially based judgments.

“I can be walking the hallway wearing a white coat,” she said, “and someone will think I’m the janitor, and I’ll think, ‘Is that because I’m black?’”

Lane-Fall recently wrote about an experience caring for a coma patient. On the third day during which the man was under her care, she happened to be in a room when the nurses were changing his gown. Spread across his chest was a tattoo: 3- to 4-inch-high lettering spelling out the words “White Power.”

At that moment, Lane-Fall recalled how she had felt nothing but coldness from the tattooed man’s family; until now, she had thought nothing of it. Now it seemed sinister.

She thought: “Oh, you’re not just this nameless, faceless person taking care of a patient; you’re a black woman who has all these other characteristics that affect the way patients see you.”

Race concordance

On the flip side, Ruchti said nurses of color she spoke with told her that patients of color sought them out on purpose. And in fact, research suggests that your health outcomes can improve if you and your physician have what’s called in the literature “race concordance.”

A Johns Hopkins study published in 2002, for example, found that, when given the choice, patients would choose doctors of their own race. And, when treated by same-race physicians, the patients reported higher satisfaction. The results cut across all races and ethnicities. The study, led by Thomas LaVeist, was one of the first of its kind.

But others soon followed. A 2005 study published in the Annals of Family Medicine found that many African-Americans and Latinos believed strongly that the health care system was racist — and that they preferred to have same-race doctors as a result.

And more recently, a 2010 study published in the Journal of the National Medical Association confirmed the previous findings: Black patients were more likely to feel that white doctors were giving them subpar care compared with black doctors and, therefore, preferred same-race health care providers.

Some will even argue that choosing a doctor of the same skin color is no different from choosing a doctor of the same gender. Many women don’t feel comfortable talking to a man about gynecological issues; is it that much of a stretch to imagine an African-American man feeling he can be more open and honest about his lifestyle and behavior with an African-American doctor?

All things being equal, if you offered me a black provider I’d probably choose that.

Dr. Meghan Lane-Fall

Preferences like these aren’t driven by ignorance. Lane-Fall got her undergraduate degree in molecular and cell biology from the University of California, Berkeley, her master’s in health policy from the University of Pennsylvania and her M.D. from Yale. She’s about as well educated as a human being could ever be. And yet, “all things being equal, if you offered me a black provider I’d probably choose that,” she said, adding that she’d assume someone from a similar background would know more about her.

Because of these complexities, the legal issues here are legion. The 1964 Civil Rights Act prohibits discrimination based on race, gender, national origin or religion in public accommodations and in any place that receives public funding. On the face of it, this would appear to mean that a patient could not make race-based requests for nurses and doctors. After all, pretty much every health care institution receives some federal funding, whether directly or in the form of public health insurance reimbursements.

But, as Paul-Emile argues, those provisions of the Civil Rights Act are actually meant to preclude institutions from “prohibiting individuals from enjoying the benefits that the institution provides” — and by accommodating a patient’s preference, “you are actually allowing that patient to enjoy the benefits” provided by a federally funded hospital.

And, in fact, that is what is happening in the real world. A 2010 study, for example, showed that patients across the board will often make race-based requests with regard to their health care provider — and that providers will often accede to these preferences. In that same study, Dr. Herbert Rakatansky, the former chair of the American Medical Association’s Council on Ethical and Judicial Affairs, is quoted as saying, “In a life-threatening situation, you would have to abide by a patient’s request.” In other words, there may be both a legal and an ethical imperative to accommodate racial preference in the hospital.

The positive preference

None of this, however, is meant to justify racism.

Paul-Emile has highlighted an important legal distinction between doctors, who can usually decide themselves whether to treat a given patient or not, and nurses and other health care support staff, who are assigned their charges. She argues that hospitals run afoul of the law when they reassign African-American nurses at a patient’s request, no matter the potential health benefits.

Gafkay, the attorney in Michigan, pointed out that all her cases involve an “organization validating the discriminatory request” — a much different situation, since it puts nurses in the precarious position of being unable to express themselves for fear of organization retribution.

Second, while it may be both legally and ethically acceptable for a patient of color to seek out a doctor of color, what about a white patient who seeks out a white doctor?

The legacy of years of racial discrimination has led to a disproportionately low number of African-American doctors. A 2009 Health System Change report, for example, found that the physician workforce was about 74 percent white and 4 percent black, while the U.S. population as a whole was 69 percent white and 12 percent black during the same year.

And one major study a few years back had patients go to doctors presenting with the exact same symptoms (which suggested cardiovascular disease), identical in every way except race and gender. Across the board, African-American women received substandard treatment and poor diagnoses.

Studies like this suggest that it’s entirely rational for an African-American patient to feel wary of the medical system. And that, Paul-Emile believes, is what should drive a physician’s decision whether or not to accommodate a racial preference.

In other words, though it may be difficult to discern a patient’s motivations, the goal of health care professionals should be to distinguish between a positive preference, in which patients are seeking better care, and discrimination, in which patients are just expressing racist beliefs.

And even then, Paul-Emile said, accommodating these positive preferences is far from ideal.

“I don’t think this is a solution,” she said. “I think it’s a stopgap measure until we get to the more fundamental issues that are driving this. The medical profession must instead increase diversity among providers to encourage tolerance and understanding of other cultures, and expand cultural awareness at all levels of practice and training to enable providers to interact more effectively with their diverse patient populations.”

Welcome to my first blog post as Director of Temple University Press. I’m thrilled to have joined the Press at an exciting time for both Temple and for the university press community. Academic and scholarly publishing has changed dramatically over the past 15 years and the Press has responded. User expectations around digital content, budgetary challenges facing university libraries, and a growing international market are just a few areas where we’re strategically developing new programs, products, and policies.

We’re not alone in adapting to the changing environment. Temple is one of 130 university presses that are members of the Association of American University Presses (AAUP), an organization of non-profit publishers from around the world through which we share information, brainstorm solutions, advocate for university presses, and advise on policy related to university publishing.

The AAUP’s 2014 Annual Meeting took place in New Orleans from June 22 to 24, and, a week into my tenure as Director, I packed my summer clothes (yes, it was hot) and my umbrella (heavy thunderstorms arrived every afternoon) and headed to NOLA. The theme of the meeting was “Open to Debate,” and the atmosphere was one of communication, collaboration, and discussion. Sessions touched on all aspects of what we in the university press community do, from print to online, books to journals, authors to librarians, acquisitions to marketing.

My AAUP conference began with the Press Directors Meeting, which this year was an advocacy workshop facilitated by Melanie Hawks from the University of Utah. It focused on influencing key partners and decision makers. According to Melanie, successful persuasion and influence–be it with your boss or your institution’s administration– hinges on being seen as credible, finding common ground and shared goals, providing evidence-based examples, and making an emotional connection. If you keep these in mind when talking with administrators, they’re likely to see the Press as an important partner that adds value to the university’s teaching, research, and public-service initiatives.

The growing importance of collaboration, in formal and informal ways, came up in several sessions. Kathleen Fitzpatrick, Director of Scholarly Communication at the Modern Language Association, using the MLA Commons as an example, posited that a scholarly society’s value could, in the future, be based on the ability to participate in group discussions, collaborate, and share work openly with the world. In another session devoted to the digital humanities, she noted that by its very nature, digital humanities work is collaborative. And Doug Armato, Director of the University of Minnesota Press, sees an increasing use of informal forms of communication, such as commentary on gray literature in their Forerunners: Ideas First series, and the collaborative development of them as a basis for more formal work.

The importance of open access – scholarly content made available on the open web – was a topic of several sessions. Presses have long welcomed dissemination of knowledge as broadly as possible regardless of business model, while at the same time noting that many of the costs associated with publication apply, again regardless of business model. The speakers in a session on library publishing programs shared examples of campus-based publishing supported from within the library and their approaches to cost recovery.

The meeting ended with a town-hall-style session, provocatively titled “The Revolution will be Subsidized,” devoted to a discussion of recent proposals from the Mellon Foundation and a scholarly communications task force of the Association of American Universities and the Association of Research Libraries. Both focused on developing new models in university press publishing, in particular subsidization of digital publication for scholarly monographs, with that subsidy coming from authors’ institutions. See Jennifer Howard’s summary of the session and the proposals in the Chronicle of Higher Education. Discussion and debate was spirited in this session and it is ongoing; stay tuned for our response as it develops.

Attending AAUP as the Director at Temple, a strong, well-known, respected press, was a great start to my tenure. I’m looking forward to working with the dedicated staff to investigate and implement what I learned.